Daniel M O'Mara1, Paul A DiCamillo2, Wesley D Gilson3, Daniel A Herzka4, Frank K Wacker5, Jonathan S Lewin1, Clifford R Weiss2. 1. Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. 2. Vascular and Interventional Radiology, Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. 3. Siemens Healthcare USA, Baltimore, Maryland, USA. 4. Department of Biomedical Engineering, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. 5. Institute for Diagnostic and Interventional Radiology, Medical School Hanover, Hanover, Germany.
Abstract
PURPOSE: To demonstrate the feasibility, safety, and effectiveness of image-guided sclerotherapy of low-flow vascular malformations using a 1.5 Tesla (T) MR scanner with real-time imaging capability and in-suite fluoroscopy. MATERIALS AND METHODS: Thirty-three procedures were performed with real-time 1.5T MR-guidance on 22 patients with a vascular malformation in the neck (n = 2), chest (n = 6), abdomen and pelvis (n = 15), and extremities (n = 11). Quantitative analysis was performed for changes in (a) planning time, (b) targeting time (interval between needle skin puncture and lesion access), (c) intervention time (interval between needle skin puncture and needle removal), and (d) total procedure time. Qualitative analysis was performed for (a) success of therapy and (b) occurrence of complications. RESULTS: Technical success was achieved in 29 of 33 procedures. The average planning time did not significantly change between the first seven procedures and the last seven procedures (P = 0.447). The average targeting time decreased by 0:24:45 (hours:minutes:seconds) (P = 0.043), the average intervention time decreased by 0:26:58 (P = 0.022), and the average procedure time decreased by 0:28:41 (P = 0.046) when comparing the first seven procedures and the last seven procedures. Overall, there was an improvement in the patients' predominant symptoms following 82% of procedures, including a significant decrease in average pain following therapy (P < 0.001). There was a minor complication rate of 3% with no major complications. CONCLUSION: MR-guided percutaneous sclerotherapy seems to be a safe, effective, and versatile technique for treating low-flow vascular malformations. LEVEL OF EVIDENCE: 3 J. Magn. Reson. Imaging 2017;45:1154-1162.
PURPOSE: To demonstrate the feasibility, safety, and effectiveness of image-guided sclerotherapy of low-flow vascular malformations using a 1.5 Tesla (T) MR scanner with real-time imaging capability and in-suite fluoroscopy. MATERIALS AND METHODS: Thirty-three procedures were performed with real-time 1.5T MR-guidance on 22 patients with a vascular malformation in the neck (n = 2), chest (n = 6), abdomen and pelvis (n = 15), and extremities (n = 11). Quantitative analysis was performed for changes in (a) planning time, (b) targeting time (interval between needle skin puncture and lesion access), (c) intervention time (interval between needle skin puncture and needle removal), and (d) total procedure time. Qualitative analysis was performed for (a) success of therapy and (b) occurrence of complications. RESULTS: Technical success was achieved in 29 of 33 procedures. The average planning time did not significantly change between the first seven procedures and the last seven procedures (P = 0.447). The average targeting time decreased by 0:24:45 (hours:minutes:seconds) (P = 0.043), the average intervention time decreased by 0:26:58 (P = 0.022), and the average procedure time decreased by 0:28:41 (P = 0.046) when comparing the first seven procedures and the last seven procedures. Overall, there was an improvement in the patients' predominant symptoms following 82% of procedures, including a significant decrease in average pain following therapy (P < 0.001). There was a minor complication rate of 3% with no major complications. CONCLUSION: MR-guided percutaneous sclerotherapy seems to be a safe, effective, and versatile technique for treating low-flow vascular malformations. LEVEL OF EVIDENCE: 3 J. Magn. Reson. Imaging 2017;45:1154-1162.
Authors: Clifford R Weiss; David R Marker; Gregory S Fischer; Gabor Fichtinger; Antonio J Machado; John A Carrino Journal: AJR Am J Roentgenol Date: 2011-03 Impact factor: 3.959
Authors: Eva Rothgang; Wesley D Gilson; Frank Wacker; Joachim Hornegger; Christine H Lorenz; Clifford R Weiss Journal: J Magn Reson Imaging Date: 2013-01-18 Impact factor: 4.813
Authors: Di Xu; Daniel A Herzka; Wesley D Gilson; Elliot R McVeigh; Jonathan S Lewin; Clifford R Weiss Journal: J Magn Reson Imaging Date: 2014-01-06 Impact factor: 4.813
Authors: Shrey K Thawait; Kate Puttgen; John A Carrino; Laura M Fayad; Sally E Mitchell; Thierry A G M Huisman; Aylin Tekes Journal: Eur J Pediatr Date: 2012-09-18 Impact factor: 3.183